This Common Secret: My Journey as an Abortion Doctor (10 page)

Toward the end of our conversation, he mentioned that he was past retirement age and anxious to spend some time on the ski slopes. He had been unable to find anyone willing to take over his practice, but he refused to close the doors. He knew that the protesters would take undeserved credit for ending abortion services in Bozeman.

I was speechless.

“Excuse me,” I mumbled. “Did you say you wanted someone to come and work for you?”

“No,” he replied. “I am looking for someone to completely take over. Someone to buy my clinic.”

I immediately knew that this was my chance, a chance I had been fantasizing about for some time. I’d looked into it enough to know that the financial risk was tremendous, the responsibility and increased exposure sobering, and the consequences for my family substantial.

But I also understood that owning and running my own facility would allow me to elevate counseling and recovery to the level I had always believed necessary, to pick everything from the décor to the music we played, and to handle each aspect of the many financial and ethical decisions without interference.

I told him I would fly out within a week. Before clinic was finally in full swing later that morning, I had already made the necessary arrangements to travel to Bozeman. I still had three days of work to focus on before the trip, but that didn’t keep me from daydreaming about providing more than just abortions. Pregnancy planning and prevention, prenatal care and births, annual exams, well-woman care—abortions are only one facet of the services available in a clinic that truly provides choices for women.

I had been doing abortions full time for less than five years but was already a veteran through working in five clinics in three states, packing in an intense amount of frontline experience. In that brief time, I had learned so much from counselors and educators and clinic directors who were all dedicated to their patients. More to the point, I had learned from the hundreds of women who presented themselves, and their life situations, to me over that time. Now I had an opportunity to take the best of each clinic, along with my accumulating experience, and fashion it into a facility with my name and style behind it.

I’m the first to admit that I like being in control. I don’t think that is a bad trait in most situations, and in the case of providing abortion services, the doctor is the one ultimately responsible. It made complete sense for me to manage the entire experience, not just the procedure.

As the doctor actually performing the abortion, the one who physically removes an embryo or fetus from the pregnant woman’s uterus, I had better be sure this is truly what she has chosen of her own free will. The clinic staff is a team. It has to be. The receptionist, the counselors, the lab techs, the surgical assistants, the nurses, and the doctor all have to be on the same page.

Still, I am the one who ends a potential human life. I am the one who lives in fear of performing an abortion on someone who will later regret it. I am the one asking a woman to lie back so that I can begin the procedure. I had better be listening to her unspoken fears and paying attention to her body language. I have to be tuned to the questions that signal ambivalence.

I have to know the subtle shades of difference between “I want,” “I need,” and “I should” for each patient on every day, no matter what else is going on to complicate or confuse the issue.

It was one of those confusing issues, and my lack of attention, that resulted in an abortion I will always regret having done.

The patient and her husband came together to the clinic. It was during one of the first years I was working full-time, and that clinic did not have an ultrasound. We estimated the stage of a patient’s pregnancy based on her last normal menstrual period (LMP) and by pelvic exam to determine the size of the uterus.

When the patient and I reviewed her medical history prior to the abortion, I asked my usual question, “Are you absolutely sure of your decision to have this abortion?” She was obviously sad, but very clear in her decision and had the complete support of her husband.

“Yes, I want to do this,” she said. “There is no way I could possibly carry this pregnancy full term. I just cannot have this baby.”

With hindsight, I should have asked a few more questions. “Why can’t you have this baby?” for example. I knew there were no medical reasons, but what was driving her? There were no clues in the notes from the counselor, and I didn’t probe further.

The patient was a large woman. Due to her size, the pelvic exam was difficult and less accurate than I liked. Her history suggested she was about eight weeks since her last menstrual period. I could tell that we were within two weeks of that. She was certainly no more than ten weeks, and probably less. I continued with an uneventful abortion. The procedure took about five minutes, and she handled it well.

We moved her to the recovery room, and the tissue we removed from the uterus was taken to the lab for evaluation. We always examine the products of conception (POC), both to confirm the stage of pregnancy and to look for any abnormal tissue. On examination of the POC, it was obvious that she was actually around ten weeks LMP, meaning she had conceived at least two weeks earlier than expected by her history. I always tell the patients if we find something unexpected.

Upon entering the recovery room, I sat down next to the patient and asked how she was coping.

“Fine. Total relief, really. If I had given birth to that baby, it would have been a constant reminder of the rape. I have always been very against abortion, but in this case it was the only thing I could do.”

I was holding my breath. This was new information to me. Was the embryo we just aborted the rapist’s or her husband’s? I stifled a gasp. Questions raced through my head. When was the rape? I had to tell her what I had found, but what if . . . ?

“Mrs. P., I don’t know when the rape was, but after looking at the tissue that came out of your uterus, I need to tell you that you conceived at least two weeks earlier than we had estimated.”

The color drained out of her face. The lines around her eyes and mouth began to change and contract. She kept moving her eyes from me to the door, as if she was about to bolt.

“What? What do you mean? When did I get pregnant? I got pregnant from the rape, right? Right?”

I tried to stand, to go to the desk to get the wheel that we use to determine weeks of pregnancy and most likely conception dates, but my legs wouldn’t work. I broke into a sweat. The nurse sitting at the desk had figured out the situation and handed me the wheel. She and I looked at each other, trying to hide the look of horror in our faces.

Together we went over the facts, the date of the rape, the stage of the pregnancy as evidenced by the POC. The pregnancy was clearly not a result of the rape.

“Oh my God, what have we done?” she choked.

Mrs. P was inconsolable. I had another staff member get her husband from the waiting room, and I had to tell him what we had learned. In a gesture that would have horrified a malpractice lawyer, I apologized over and over. The three of us cried together. This pregnancy, this baby, would have been very welcomed and loved had they known it was theirs. But now it was ended, and I felt responsible. I was responsible.

We spent lots of time, the three of us, trying to comfort each other. Before they left, we exchanged home phone numbers, promised to talk again soon. They never blamed me or threatened legal action against me or the clinic. We all had counseling to deal with the guilt and sadness over the event. More than anything, I learned to never assume anything, to always ask the questions in my heart, to listen to what wasn’t said, to pay attention to my intuition, and to never do an abortion without having an ultrasound first.

Another thing I learned from that patient and her partner: how great is the gift of forgiveness. I was still trying to forgive the doctor who did my abortion years ago. Not because I had any regrets, but because of the terrible way I was treated. Every single day I worked, and with each patient I treated, I remembered that abortion. At the core, I was determined to make my patients’ experiences better than mine had been.

A clinic facility that expressed my priorities, my values, and my style was taking shape in my imagination when I flew into Bozeman. The plane banked over the Bridger Mountains. The broad Gallatin River valley spread below, surrounded by mountain ranges. I could barely contain my excitement.

Two summers before I had visited Montana for the first time, joining a group of friends for a horse pack trip in the Bob Marshall Wilderness. I had spent eight days in the backcountry. Eight days free of protesters. Eight days away from television, away from news of the outside world. There, I gained a sense of peace I had never known before. I recognized that the mountains offered me a refuge, a place where I could renew myself, and I had dreamed of that possibility ever since. In Bozeman I could do the work I loved and have the solace I needed out my back door.

The airport had just two gates. All the faces were friendly and open. Walking from the plane into the main building I could feel the cold, dry air—a welcome change from the thick humidity in the Midwest. I felt as if I were home, as if the mountains were holding their ridges out to me in an embrace.

Dr. Balice met me at the baggage claim. A small man with a big grin and a cowboy hat, he was gracious and talkative and excited. We drove right to the clinic, and I immediately saw some of its advantages. It was in a building with many other offices: a dentist, an accountant, a few doctors, the American Red Cross, a surgery center, a pharmacy, and a medical lab. Being in a building with other businesses would prevent the clinic from becoming an isolated target. Protesters would have a harder time singling out women entering the building for abortion services. The activity and variety would make it difficult for them to harass and pinpoint the staff and patients. From the first, I liked it.

When I walked through the door, I noticed a stained glass panel made by Dr. Balice. But then I looked past everything else and started to sketch in my own clinic. I could imagine the comfortable chairs and alternative magazines in the waiting room. I could see Carol Griggs’s prints on the walls and hear Tracy Chapman music. I would have coffee and juice and snacks available. Everything would be arranged to help calm and reassure patients, encouraging them to be informed partners in the process.

The clinic was small. As I walked through, I brain-stormed the layout I’d design. A room with nice windows had great potential for a counseling space. I would furnish it with a small couch, a rocker, and a small desk. Maybe I’d install a fish tank for a focal point when discussions were tough. The view out the third floor window framed the peaks of the Bridger Range, and that high up, curtains wouldn’t be needed.

Two other rooms would be the exam and procedure rooms, with a small lab adjacent. I could see remodeling possibilities that would provide a separate entrance/exit into the recovery room for patient privacy. I would get overstuffed couches that pushed back into recliners so patients could get comfortable while recovering. It would be a quiet room with more to eat, lots to read, and an ambiance designed to provide support and healing.

Within twenty-four hours of my arrival, Dr. Balice and I had come to an agreement on terms and timing. I would come back shortly after Christmas. I planned to open my doors in February of 1993. I was beside myself with excitement, leavened with more than a little apprehension.

Neither Randy nor Sonja had any intention of being uprooted, and until we knew the clinic would actually be a success, it didn’t make sense for them to move anyway. Randy had just finished college and begun an engineering career. Sonja had more than two years of high school left. She was completely engaged in her education and friends. My work had asked so much of her already. The last thing I could expect was for her to leave home.

I needed a place to live in Bozeman three nights a week. The other days I would come back to the Midwest and continue to work at two clinics I had been serving for four years. I’d get one day a week with my family, if everything went without a hitch.

The month of January was crammed with preparing for my own medical practice—legal considerations, writing protocols, gathering medical supplies and equipment, and finding a place to live. For a time I felt, and in fact was, incredibly isolated. I had few friends or contacts and lived a kind of obsessive existence in which my clinic became my central and only focus.

In mid-January I found a small apartment just six blocks away from the medical building. I took every precaution I could think of to keep the location a secret. I never walked directly to the apartment. I’d walk a circuitous route, usually heading out in the opposite direction, making stops along the way, coming and going at different times. Sometimes I’d duck into a restaurant, sit alone at a table for an hour, then leave by the back door. I never spoke to any of the other tenants in the apartment complex, which is completely contrary to my nature. I longed to make small talk, meet people who smiled as we passed outside the building, find out about the town, live normally.

Often as not, the easiest thing was to spend the night at the office. I was afraid to walk home alone after dark. I had so much to do. I slept on the recliner in the recovery room. Staff would bring me coffee and bagels in the morning.

Most of Dr. Balice’s staff stayed on to help me get things up and running, but did not intend to stay long term. That meant hiring new people. The responsibility of handpicking my staff was as exciting as it was daunting. The first position I filled was the clinic manager. The woman I hired was perfect. Stacy was dedicated, professional, determined, and excellent with patients. She also had a great instinct when hiring other new staff, and soon we had a team assembled I felt comfortable and confident with.